Korean J Radiol.  2018 Dec;19(6):1031-1041. 10.3348/kjr.2018.19.6.1031.

Image Quality and Radiation Dose of High-Pitch Dual-Source Spiral Cardiothoracic Computed Tomography in Young Children with Congenital Heart Disease: Comparison of Non-Electrocardiography Synchronization and Prospective Electrocardiography Triggering

• Goo HW

• KMID: 2424843
• DOI: http://doi.org/10.3348/kjr.2018.19.6.1031

Abstract

OBJECTIVE
To compare image quality and radiation dose of high-pitch dual-source spiral cardiothoracic computed tomography (CT) between non-electrocardiography (ECG)-synchronized and prospectively ECG-triggered data acquisitions in young children with congenital heart disease.
MATERIALS AND METHODS
Eighty-six children (≤ 3 years) with congenital heart disease who underwent high-pitch dual-source spiral cardiothoracic CT were included in this retrospective study. They were divided into two groups (n = 43 for each; group 1 with non-ECG-synchronization and group 2 with prospective ECG triggering). Patient-related parameters, radiation dose, and image quality were compared between the two groups.
RESULTS
There were no significant differences in patient-related parameters including age, cross-sectional area, body density, and water-equivalent area between the two groups (p > 0.05). Regarding radiation dose parameters, only volume CT dose index values were significantly different between group 1 (1.13 ± 0.09 mGy) and group 2 (1.07 ± 0.12 mGy, p < 0.02). Among image quality parameters, significantly higher image noise (3.8 ± 0.7 Hounsfield units [HU] vs. 3.3 ± 0.6 HU, p < 0.001), significantly lower signal-to-noise ratio (105.0 ± 28.9 vs. 134.1 ± 44.4, p = 0.001) and contrast-to-noise ratio (84.5 ± 27.2 vs. 110.1 ± 43.2, p = 0.002), and significantly less diaphragm motion artifacts (3.8 ± 0.5 vs. 3.7 ± 0.4, p < 0.04) were found in group 1 compared with group 2. Image quality grades of cardiac structures, coronary arteries, ascending aorta, pulmonary trunk, lung markings, and chest wall showed no significant difference between groups (p > 0.05).
CONCLUSION
In high-pitch dual-source spiral pediatric cardiothoracic CT, additional ECG triggering does not substantially reduce motion artifacts in young children with congenital heart disease.

Keyword

Cardiothoracic CT; Congenital heart disease; Child; High-pitch dual-source spiral CT; Electrocardiography synchronization

MeSH Terms

Aorta
Artifacts
Child*
Cone-Beam Computed Tomography
Coronary Vessels
Diaphragm
Electrocardiography*
Heart Defects, Congenital*
Humans
Lung
Noise
Prospective Studies*
Retrospective Studies
Signal-To-Noise Ratio
Thoracic Wall

Figure

• 

  Fig. 1 77-day-old boy with coarctation of aorta.A. CT scout image shows ECG cables (arrows) for prospective ECG triggering. ECG electrodes placed on both arms are not shown on CT scout image. B. Axial CT image showing left-side ECG cable (arrow) causing mild streak artifact. Mild streak artifacts also are shown around RA. As result, degree of streak artifacts was assessed as grade 3 indicating mildly degraded image quality. C. Axial CT image at level of aortic sinus shows locations of three rectangular regions of interest for measuring CT densities in descending aorta (1), paraspinal muscle (2), and air (3). CT = computed tomography, ECG = electrocardiography, RA = right atrium

• 

  Fig. 2 Scan period positions in prospectively ECG-triggered high-pitch dual-source cardiothoracic CT scanning on ECG.A. In 77-day-old boy with coarctation of aorta and cervical aortic arch, scanning period on ECG, indicated by rectangle, is optimally located, starting from T wave and finishing with P wave peak. B. In contrast, scanning period on ECG, indicated by rectangle, is poorly positioned, overlapping with R wave in 13-day-old boy with hypoplastic left heart syndrome.

• 

  Fig. 3 Coronary artery motion artifact grading of high-pitch dual-source cardiothoracic CT.A. Oblique coronal CT image acquired with prospective ECG triggering in 35-day-old boy with coarctation of aorta demonstrates severe motion artifacts on coronary arteries that corresponded to grade 1. Oblique CT images (B, C) acquired without ECG synchronization in 1-day-old girl with coarctation of aorta illustrate moderate motion artifacts on coronary arteries, especially right coronary artery, which correspond to grade 2. Oblique CT images (D, E) acquired without ECG synchronization in an 11-month-old boy with surgically closed atrial septal defect reveal mild motion artifacts (grade 3), especially on right coronary artery, including doubling artifact (arrow) at proximal segment. Oblique CT images (F–I) acquired without ECG synchronization in 6-month-old boy with double-outlet right ventricle show no motion artifacts on coronary arteries including left main artery, left anterior descending artery, left circumflex artery, and right coronary artery that corresponded to grade 4. A = ascending aorta, LA = left atrium, LAD = left anterior descending artery, LCx = left circumflex artery, LM = left main artery, LV = left ventricle, P = pulmonary trunk, RCA = right coronary artery

• 

  Fig. 4 Lung window setting CT images illustrating motion artifacts in lung markings and diaphragms.A. Coronal CT image acquired without ECG synchronization in 6-month-old boy with functional single ventricle shows moderate degrees of motion artifacts (grade 2) in lung markings as well as in diaphragm. B. Coronal CT image acquired without ECG synchronization in 3-year-old boy with repaired coarctation of aorta displays no motion artifacts (grade 4) in lung markings as well as diaphragm.

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